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The aim of this study was to evaluate the safety of drinking carbohydrate-containing fluids two hours prior to surgery in older adults using ultrasonography.We conducted a nonrandomized and noninferiority comparative study in 60 patients aged over 65 yr who were scheduled for total knee arthroplasty. Patients who were fasted from midnight (fasting group) or who drank 400 mL of a carbohydrate-containing fluid (carbohydrate ingestion group) two hours prior to surgery were matched for age, sex, and body mass index. We measured the cross-sectional area (CSA) of gastric antrum using ultrasound and estimated the gastric fluid volume as the study's primary outcome measure. The noninferiority margin (δ) for the mean difference was predefined as 50 mL. The secondary outcome measures included CSA of the antrum and qualitative gastric volume.The mean (standard deviation) gastric volume was not significantly different between the fasting group and the carbohydrate ingestion group (30.2 [25.4] mL vs 28.4 [35.8] mL; each group, n = 30; P = 0.81). The mean difference in gastric volume was -1.9 mL (95% confidence interval [CI], -17.9 to 14.2), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit (δ = 50 mL). Secondary outcomes were not significantly different between the two groups.Drinking of carbohydrate-containing fluid two hours prior to surgery was noninferior to overnight fasting with respect to residual gastric volume at induction of anesthesia in healthy older adults who undergoing total knee arthroplasty.ClinicalTrials.gov (NCT04514380); registered 14 August 2020.RéSUMé: OBJECTIF: L’objectif de cette étude était d’évaluer l’innocuité de la consommation d’une préparation glucidique deux heures avant une chirurgie chez les personnes âgées à l’aide de l’échographie. MéTHODE: Nous avons mené une étude comparative non randomisée et de non-infériorité chez 60 patients âgés de plus de 65 ans qui devaient bénéficier d’une arthroplastie totale du genou. Les patients étaient à jeun depuis minuit (groupe à jeun) ou avaient bu 400 mL d’une préparation glucidique (groupe d’ingestion de glucides) deux heures avant la chirurgie et ont été appariés pour l’âge, le sexe et l’indice de masse corporelle. Nous avons mesuré la section transversale de l’antre gastrique à l’aide de l’échographie et estimé le volume de liquide gastrique en tant que mesure du critère d’évaluation principal de l’étude. La marge de non-infériorité (δ) pour la différence moyenne a été prédéfinie à 50 mL. Les mesures de critères d’évaluation secondaires comprenaient la section transversale de l’antre et le volume gastrique qualitatif. RéSULTATS: Le volume gastrique moyen (écart type) n’était pas significativement différent entre le groupe à jeun et le groupe d’ingestion de glucides (30,2 [25,4] mL vs 28,4 [35,8] mL; chaque groupe, n = 30; P = 0,81). La différence moyenne de volume gastrique était de -1,9 mL (intervalle de confiance [IC] à 95 %, -17,9 à 14,2), et la limite supérieure de l’IC 95 % était inférieure à la limite de non-infériorité prédéfinie (δ = 50 mL). Aucune différence intergroupe significative n’a été observée dans les critères d’évaluation secondaires. CONCLUSION: La consommation d'une préparation glucidique deux heures avant la chirurgie n'était pas inférieure au jeûne nocturne en ce qui concerne le volume gastrique résiduel à l'induction de l'anesthésie chez les personnes âgées en bonne santé qui bénéficient d'une arthroplastie totale du genou. ENREGISTREMENT DE L'éTUDE: www.ClinicalTrials.gov (NCT04514380); enregistrée le 14 août 2020.

BACKGROUND The role of intraoperative magnesium for the prevention of emergence agitation or delirium is unclear as there have been conflicting results reported by several randomized controlled trials. AIMS The aim of this study was to investigate the effect of magnesium sulfate on emergence agitation or emergence delirium in pediatric patients. METHODS Electronic databases, including PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and Web of Science, were searched to identify studies which evaluated the effects of magnesium on postoperative emergence agitation or emergence delirium. The primary outcome was the incidence of emergence agitation or emergence delirium during the post-anesthesia stay. The secondary outcome was the agitation or delirium score upon admission to the post-anesthesia care unit. We estimated the odds ratio and standardized mean difference using a random-effect model. RESULTS A total of 712 pediatric patients from 10 randomized controlled trials were included in the final analysis. The incidence of emergence agitation or emergence delirium was 29.7% in the magnesium group and 50.5% in the control group. The pooled effect size revealed that the administration of magnesium sulfate significantly reduced the incidence of postoperative emergence agitation or emergence delirium in pediatric patients undergoing surgery with general anesthesia (Odds ratio, 0.31; 95% confidence interval, 0.15 to 0.64; p = 0.002). Additionally, children in the magnesium group reported significantly lower agitation or delirium scores than those in the control group (standardized mean difference, -0.70; 95% confidence interval, -1.15 to -0.24; p = 0.003). CONCLUSION The administration of magnesium sulfate reduced the incidence and severity of emergence agitation or emergence delirium in pediatric patients after the use of general anesthesia during surgery.

Background Acute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units. Methods/design This is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow up at our outpatient clinic on the first postoperative day and at 1 week after surgery. The primary outcome is pain intensity, which will be measured using the visual analog scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 h and 1 week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height). Discussion This trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management. Trial registration ClinicalTrials.gov NCT04754451. Registered on February 10, 2021.

This study aimed to identify the benefits of thoracic paravertebral block (PVB) by focusing on its role in reducing chronic postsurgical pain (CPSP) after thoracic surgery.A systematic review and meta-analysis of randomized controlled trials (RCTs).Electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, were searched to identify studies.Patients undergoing thoracic surgeries.Paravertebral block for postoperative analgesia.A total of 1,028 adult patients from 10 RCTs were included in the final analysis. The incidence of CPSP at 3 months after surgery was not reduced in the PVB group compared with the no-block (odds ratio [OR] 0.59, 95% CI 0.34-1.04; p = 0.07; IThoracic PVB does not prevent CPSP after thoracic surgery. Further large RCTs are required to confirm and validate the authors' results.

In general, lignin exhibits unpredictable and nonuniform thermal properties due to the structural variations caused by the extraction processes. Therefore, a systematic understanding of the correlation between the extraction conditions, structural characteristics, and properties is indispensable for the commercial utilization of lignin. In this study, the effect of extraction conditions on the structural characteristics of ethanol organosolv lignin (EOL) was investigated by response surface methodology. The structural characteristics of EOL (molecular weight, hydroxyl content, and intramolecular coupling structure) were significantly affected by the extraction conditions (temperature, sulfuric acid concentration, and ethanol concentration). In addition, the correlation between the structural characteristics and thermal properties of the extracted EOLs was estimated. The relevant correlations between the structural characteristics and thermal properties were determined. In particular, EOLs that had a low molecular weight, high phenolic hydroxyl content, and low aryl–ether linkage content exhibited prominent thermal properties in terms of their initial decomposition rate and a high glass transition temperature, Tg. Correspondingly, EOL-PLA blends prepared using three EOL types exhibited improved thermal properties (starting point of thermal decomposition and maximum decomposition temperature) compared to neat PLA and had thermal decomposition behaviors coincident with the thermal properties of the constituent EOLs.

Postoperative nausea and vomiting (PONV) occurs frequently after bariatric surgery and is a major cause of adverse outcomes. This retrospective study investigated whether opioid-restricted total intravenous anesthesia using dexmedetomidine as a substitute for remifentanil can reduce PONV in bariatric surgery.The electronic medical records of adult patients who underwent laparoscopic bariatric surgery between January and December 2019 were reviewed. The patients were divided into two groups according to the agents used for anesthesia: Group D, propofol and dexmedetomidine; Group R, propofol and remifentanil.A total of 134 patients were included in the analyses. The frequency of postoperative nausea was significantly lower in Group D than that in Group R until 2 h after discharge from the postanesthesia care unit (PACU) (P = 0.005 in the PACU, P = 0.010 at 2 h after PACU discharge) but failed to significantly reduce the overall high incidence rates of 60.5% and 65.5%, respectively (P = 0.592). Postoperative pain score was significantly lower in Group D until 6 h after PACU discharge. The rates of rescue antiemetic and analgesic agent administration in the PACU were significantly lower in Group D than those in Group R.Opioid-restricted total intravenous anesthesia using dexmedetomidine reduces postoperative nausea, pain score, antiemetic, and analgesic requirements in the immediate postoperative period after bariatric surgery.

Background Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear. Methods This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling. Results Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46–0.96, P=0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77–0.83, P Conclusions Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.

Modified autohydrolysis combined with mechanical refining has been suggested to recover free sugars from sweet sorghum bagasse and facilitates enzyme access to cellulose in bagasse for enhancing its conversion to fermentable sugars. The amount of total available sugars in sweet sorghum bagasse was found to be 76.1% and this value was used to evaluate the efficiency of the process suggested. Total sugar recovery was achieved up to 68.1% through the single-stage autohydrolysis at 170 °C for 60 min, followed by mechanical refining and enzymatic hydrolysis; however, the sugar recovery through partial degradation of free sugars induced by high-temperature autohydrolysis was lower than expected. A modified two-stage autohydrolysis was suggested to prevent sugar degradation and the total sugar recovery using this process reached 83.9% of total available sugars in sweet sorghum bagasse.

The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( p

Background: Deep neuromuscular blockade is considered beneficial for improving the surgical space condition during laparoscopic surgery. Adequacy of the surgical space condition may affect the anesthetists’ decision regarding titration of depth of anesthesia. We investigated whether deep neuromuscular blockade reduces the propofol requirement under bispectral index monitoring compared to moderate neuromuscular blockade. Methods: Adult patients undergoing elective laparoscopic colorectal surgery were randomly allocated to a moderate or deep group. A train-of-four count of 1–2 in the moderate group, and a post-tetanic count of 1–2 in the deep group, were maintained by continuous infusion of rocuronium. The induction and maintenance of anesthesia were achieved by target-controlled infusion of propofol and remifentanil. The dose of propofol was adjusted to maintain the bispectral index in the range of 40–50. The remifentanil dose was titrated to maintain the systolic blood pressure to within 20% of the ward values. Results: A total of 82 patients were included in the analyses. The mean±SD dose of propofol was 7.54 ± 1.66 and 7.42 ± 1.01 mg·kg−1·h−1 in the moderate and deep groups, respectively (P = .104). The mean±SD dose of remifentanil was 4.84 ± 1.74 and 4.79 ± 1.77 μg kg−1 h−1 in the moderate and deep groups, respectively (P = .688). In comparison to the moderate group, the deep group showed significantly lower rates of intraoperative patient movement (42.9% vs 22.5%, respectively, P = .050) and additional neuromuscular blocking agent administration (76% vs 53%, respectively, P = .007). Postoperative complications, including pulmonary complications, wound problems and reoperation, were not different between the two groups. Conclusion: Deep neuromuscular blockade did not reduce the bispectral index-guided propofol requirement compared to moderate neuromuscular blockade during laparoscopic colon surgery, despite reducing movement of the patient and the requirement for a rescue neuromuscular blocking agent. Trial registration: Clinicaltrials.gov (NCT03890406)

The risk of neuromuscular blockade is certainly minimized by sugammadex in combination with monitoring. However, the effect of sugammadex-aided recovery on patients’ satisfaction is unclear. This study compared the Quality of Recovery (QoR)-15 score, which is a patient-reported outcome, in patients undergoing laparoscopic cholecystectomy. Eighty patients were randomly assigned to the neostigmine or sugammadex groups. At the end of surgery, neostigmine or sugammadex was administered, and tracheal extubation was performed after confirmation of a train of four ratio ≥ 0.9. The QoR-15 questionnaire was administered at 1 day before surgery and on post-operative days (POD) 1 and 2. The primary outcome was the QoR-15 score on POD 1. The secondary outcomes were the QoR-15 score on POD 2, modified Aldrete score, length of post-anesthetic care unit stay, post-operative pain, administration of anti-emetics, urinary retention, and length of hospital stay. No significant differences were found in QoR-15 scores on POD 1 (94.4 vs. 95.5, p = 0.87) or 2 (116.3 vs. 122, p = 0.33). Secondary outcomes were also comparable, with the exception of urinary retention (15.8% neostigmine vs. 2.6% sugammadex, p = 0.04). This study demonstrated that the quality of recovery was comparable between the neostigmine and sugammadex groups when reversal and tracheal extubation were performed in accordance with the current guidelines.

The main purpose of this study was to investigate the glucan conversion rate after enzymatic hydrolysis depending on the treatment methods and conditions with changes in the chemical composition of treated solid fraction of Jabon Merah. The glucan conversion rate (17.4%) was not significantly improved after liquid hot water treatment (1st step) even though most of the hemicellulose was dissolved into liquid hydrolysate. Subsequently, dilute acid, organosolv, and peracetic acid treatment (2nd step) was conducted under various conditions to enhance glucan conversion. Among the 2nd step treatment, the glucan conversion rate of organosolv (max. 46.0%) and peracetic acid treatment (max. 65.9%) was increased remarkably through decomposition of acid-insoluble lignin (AIL). Finally, the glucan conversion rate and AIL content were highly correlated, which was revealed by the R-squared value (0.84), but inhibitory factors including cellulose crystallinity must be considered for advanced glucan conversion from highly recalcitrant biomasses, such as Jabon Merah.

Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg-1 with neostigmine (50 μg.kg-1 with glycopyrrolate 10 μg.kg-1 ) reversal (moderate block group) vs. rocuronium 0.90 mg.kg-1 with sugammadex (4 mg.kg-1 ) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat. The onset of neuromuscular block was more rapid, and intubation conditions and ease of intra-operative laryngoscopy were more favourable, and the satisfaction score was lower in the moderate block group compared with the deep block group. No difference was found in the incidence of postoperative sore throat. In laryngeal micro-surgery, the use of rocuronium 0.9 mg.kg-1 with sugammadex for reversal was associated with better surgical conditions and a shorter recovery time than rocuronium 0.45 mg.kg-1 with neostigmine.

Background: Tranexamic acid (TXA) is the most widely used hemostatic agent in surgical patients. However, when used in a high dose, it could cause a seizure in the postoperative period. The exact effector mechanism behind the seizure triggering remains unknown. Therefore, the authors investigated the effects of TXA on the activity of glutamate transporter type 3 (excitatory amino acid transporter 3; EAAT3), which is the main neuronal glutamate transporter type. Methods: EAAT3 was expressed in Xenopus laevis oocytes through mRNA injection. Oocytes were incubated with diluted tranexamic acid for 72 h. Two-electrode voltage clamping was used to measure membrane currents before, during, and after applying 30 M L-glutamate. Responses were quantified by integrating the current traces and reported in microcoulombs (C). Results were presented as mean  SEM.Results: TXA (30 to 1,000 M) significantly decreased EAAT3 activity. Our kinetic study showed that Vmax was significantly decreased in the TXA group compared with the control group (1.1  0.1 vs. 1.4  0.1 C, n = 18–23, P = 0.043), but the Km did not significantly change (12.7  3.9 M for TXA vs. 12.8  3.8 for control, n = 18–23, P = 0.986).Conclusions: Our results suggest that TXA attenuates EAAT3 activity, which may explain its proconvulsant effect.

Objective: Previous studies have reported that propofol has antitumor, anti-inflammatory, and antioxidant effects in addition to its anesthetic properties. To confirm this, a retrospective investigation was conducted to determine whether different anesthetic agents, particularly propofol and inhalation anesthetics, have an effect on the recurrence of hepatocellular carcinoma (HCC) in patients who were diagnosed with primary HCC and underwent laparoscopic hepatectomy. Subjects and Methods: Patients with Barcelona Clinic Liver Cancer stages 0, A, and B HCC, who underwent laparoscopic hepatic resection, were enrolled in this study. Post­operative HCC recurrence, which was determined from postoperative liver CT, was evaluated 24 months postoperatively with respect to the main anesthetic agents. The characteristics of HCC and other patient-related or surgery-related variables were evaluated together. Results and Conclusion: During the 24-month period after hepatic resection, less HCC patients in the propofol group than in the inhalation group recurred (p = 0.046). The mean time to recurrence was 20.8 months (95% CI, 19.7–22.0) and 19.1 months (95% CI, 17.8–20.4) in the propofol group and the inhalation group, respectively. In addition, multivariable Cox proportional regression analysis revealed that the propofol group showed significantly decreased recurrence versus the inhalation group (hazard ratio, 0.57; 95% CI, 0.47–0.69; p = 0.029). When propofol was used as the main general anesthetic agent for laparoscopic hepatic resection, the postoperative 2-year recurrence rate decreased in early- and intermediate-stage HCC.

Maintaining deep neuromuscular block during surgery improves surgical space conditions. However, its effects on patient outcomes have not been well documented. We examined whether maintaining deep neuromuscular blockade during surgery could decrease the stress response compared to moderate neuromuscular blockade. Patients undergoing laparoscopic gastrectomy were randomly allocated to either the moderate (train-of-four counts of 1–2) or deep (post-tetanic counts of 1–2) neuromuscular blockade group. The primary outcome variable was the postoperative blood level of interleukin-6, and the secondary outcome variables were intraoperative or postoperative blood levels of tumor necrosis factor-α, interleukin-1β, interleukin-8, and C-reactive protein. A total of 96 patients were recruited and 88 (44 in each group) were included in the analyses. The levels of tumor necrosis factor-α and interleukin-1β measured at the end of surgery, interleukin-6 and interleukin-8 measured at 2 h postoperatively, and C-reactive protein measured at 48 h postoperatively were all significantly increased compared to the preoperative values, but there were no differences between the moderate and deep neuromuscular block groups. We found no differences in surgical stress response measured using determining levels of interleukin-6 and other mediators released between the moderate and deep neuromuscular blockade groups in patients undergoing laparoscopic gastrectomy.

The main purpose of this study was to produce succinic acid from hemicellulose in lignocellulosic biomass by successive process without purification as a biorefinery concept. Liquid hot water (LHW) treatment was conducted to extract water soluble hemicelluloses from Quercus mongolica to produce furfural from lignocellulosic biomass. Additional acid catalyzed dehydration was conducted to liquid hydrolysate from LHW treatment for furfural production. At 170 °C of reaction temperature, 42% of furfural yield was achieved from pentose in liquid hydrolysate. This Acid treated liquor (ATL) was treated with hydrogen peroxide to oxidize furfural to C4 dicarboxylic acid such as succinic or maleic acid. Main product was succinic acid which is produced by oxidation of furfural, and minor amount of maleic acid was produced via oxidation. The xylose was degraded to furfural and then oxidized to succinic acid, while acid soluble lignin inhibited succinic acid production by reacting with intermediates of succinic acid. This results indicated that hemicellulose rich liquid hydrolysate has potential to source for succinic acid without further purification.

Polyhydroxyalkanoate (PHA) is a biodegradable plastic with great potential for tackling plastic waste and marine pollution issues, but its commercial applications have been limited due to its poor processability. In this study, surface-modified cellulose nanocrystals were used to improve the mechanical properties of PHA composites produced via a melt-extrusion process. Double silanization was conducted to obtain hydrophobically treated CNC-based fillers, using tetraethyl orthosilicate (TEOS) and methyltrimethoxysilane (MTMS). The morphology, particle size distributions, and surface characteristics of the silanized CNCs and their compatibility with a PHA polymer matrix differed by the organosiloxane treatment and drying method. It was confirmed that the double silanized CNCs had hydrophobic surface characteristics and narrow particle size distributions, and thereby showed excellent dispersibility in a PHA matrix. Adding hydrophobically treated CNCs to form a PHA composite, the elongation at break of the PHA composites was improved up to 301%, with little reduction of Young’s modulus, compared to pure PHA. Seemingly, the double silanized CNCs added played a similar role to a nucleation agent in the PHA composite. It is expected that such high ductility can improve the mechanical properties of PHA composites, making them more suitable for commercial applications.

Water electrification mechanism is gradually being identified, and utilized to harvest various types of water-based energy. However, a lack of understanding of the complementary characteristics of water in real environment, such as the complex dynamics of droplet flow, phase change, high temperature, and humid conditions, continues to limit the realization of water-based energy harvesting. Here, we demonstrated the mechanism of condensed droplet-based electricity generation via water-phase change for the first time. The various characteristic electrical outputs were observed in a series of condensation processes (nucleation, growth, shedding, sweeping, separation, drop off). Furthermore, the correlation among the electrical outputs, heat flux, and condensation rate were identified. The distinct changes in the electrical outputs depending on changes in the heat flux changes can be utilized to detect sudden failures of heat exchanges and coolers.

The beneficial effects of deep blockade are not fully known. In this study, we evaluated the effect of deep neuromuscular blockade on surgical conditions during laparoscopic cholecystectomy under low-pressure pneumoperitoneum. Patients undergoing elective laparoscopic cholecystectomy were randomized to either the moderate group (train-of-four count of 1 or 2) or deep group (posttetanic count of 1 or 2). Neuromuscular blockade was induced and maintained with rocuronium; it was reversed with sugammadex in the deep group and with neostigmine in the moderate group. At the beginning of surgery, the intra-abdominal pressure was set at 8 mmHg. The surgeon rated the surgical condition on a 4-point scale (1 = excellent, 2 = good, 3 = acceptable, 4 = poor) and was allowed to increase the pressure to 12 mmHg if it was determined that the surgical conditions were inadequate for the operation. A total of 64 patients completed the study. The rate of increasing intra-abdominal pressure to maintain optimal surgical conditions was 34.4 % in the moderate group and 12.5 % in the deep group (P = 0.039). The proportion of patients with a surgical condition score of 1 or 2 (excellent or good) was 34.4 % in the moderate group and 68.8 % in the deep group (P = 0.006). The maintenance of intraoperative deep neuromuscular blockade was associated with a lower rate of conversion to standard pressure and higher surgeon satisfaction with the surgical conditions than was moderate blockade in patients undergoing low-pressure pneumoperitoneum laparoscopic cholecystectomy.

The degree of neuromuscular blockade is one of the important factors that determine the condition of surgical space during laparoscopic surgery. Magnesium sulfate potentiates the actions of neuromuscular blocking agent, and we hypothesized that intraoperative magnesium sulfate infusion may improve surgical space condition during laparoscopic surgery. Eighty-four patients undergoing elective laparoscopic gastrectomy were randomized to receive isotonic saline (group C) or magnesium sulfate (group M, loading dose with 50 mg/kg over 10 min and then 15 mg/kg/h by continuous infusion) to maintain the moderate neuromuscular blockade using rocuronium. Two experienced surgeons scored the quality of surgical space condition using a 5-point surgical rating scale (SRS). The secondary outcomes included recovery profiles, postoperative pain and adverse events. The SRS in group M was higher than that of group C. The proportion of patients with a SRS of 5 (optimal) was 2.7 % in the group C and 40.5 % in the group M (P

Lignin is regarded as a potential source of various aromatic compounds and chemicals, replacing petrochemicals. Catechol and its derivatives are important platform chemicals in many industrial sectors, including agrochemicals and pharmaceuticals. The global market of catechols is expected to increase with emerging demand in end-use industries. Considering that the current production of catechols relies on fossil fuels, it is critical to seek alternative renewable sources to respond to sustainability challenges. In this respect, lignin is viewed as a promising material due to its abundance and renewable character. Also, the structural similarity to catechols has made lignin a potential feedstock for the production of bio-catechols. However, the lignin-to-catechols conversion approach is still in an early stage because the intractable nature of lignin and the complex mixture of the depolymerized products make its valorization less feasible. Herein, we report a selective production of catechols via tandem conversion of lignin, namely, demethylation followed by catalytic hydrogenolysis (DFCH). The DFCH of lignin resulted in catechol- and catechol derivatives-rich liquid, accounting for 80 % in the identified products. The reaction mechanisms were also studied by quantum calculations to provide a fundamental understanding of the conversion. The result proves that selective modification of lignin structure is a promising approach to produce specific platform chemicals, providing insights toward an efficient strategy for lignin valorization.

This study optimizes furfural production from pentose released in the liquid hydrolysate of hardwood using an aqueous biphasic system. Dilute acid pretreatment with 4% sulfuric acid was conducted to extract pentose from liquid Quercus mongolica hydrolysate. To produce furfural from xylose, a xylose standard solution with the same acid concentration of the liquid hydrolysate and extracting solvent (tetrahydrofuran) were applied to the aqueous biphasic system. A response surface methodology was adopted to optimize furfural production in the aqueous biphasic system. A maximum furfural yield of 72.39% was achieved at optimal conditions as per the RSM, a reaction temperature of 170 &deg, C, reaction time of 120 min, and a xylose concentration of 10 g/L. Tetrahydrofuran, toluene, and dimethyl sulfoxide were evaluated to understand the effects of the solvent on furfural production. Tetrahydrofuran generated the highest furfural yield, while DMSO gave the lowest yield. A furfural yield of 68.20% from pentose was achieved in the liquid hydrolysate of Quercus mongolica under optimal conditions using tetrahydrofuran as the extracting solvent. The aqueous and tetrahydrofuran fractions were separated from the aqueous biphasic solvent by salting out using sodium chloride, and 94.63% of the furfural produced was drawn out through two extractions using tetrahydrofuran.

The effect of drying on the enzymatic hydrolysis of cellulose was determined by analysis of porosity and crystallinity. Fiber hornification induced by drying produced an irreversible reduction in pore volume due to shrinkage and pore collapse, and the decrease in porosity inhibited enzymatic hydrolysis. The drying effect index (DEI) was defined as the difference in enzymatic digestibility between oven- and never-dried pulp, and it was determined that more enzymes caused a higher DEI at the initial stage of enzymatic hydrolysis and the highest DEI was also observed at the earlier stages with higher enzyme dosage. However, there was no significant difference in the DEI with less enzymes because cellulose conversion to sugars during hydrolysis did not enhance enzymatic hydrolysis due to the decrease in enzyme activity. The water retention value (WRV) and Simons&rsquo, staining were used to measure pore volume and to investigate the cause of the decrease in enzymatic hydrolysis. A decrease in enzyme accessibility induced by the collapse of enzymes&rsquo, accessible larger pores was determined and this decreased the enzymatic hydrolysis. However, drying once did not cause any irreversible change in the crystalline structure, thus it seems there is no correlation between enzymatic digestibility and crystalline structure.

Magnesium sulfate can be used as a co-adjuvant drug during the perioperative period and has multiple benefits. Recent evidence suggested that perioperative magnesium sulfate infusion may lower the risk of postoperative acute kidney injury (AKI). We investigated the association between intraoperative magnesium sulfate infusion and incidence of AKI after major laparoscopic abdominal surgery. We retrospectively analyzed the medical records of adult patients 20 years or older who underwent elective major laparoscopic abdominal surgery (>2 hours) between 2010 and 2016. We investigated the association between intraoperative magnesium sulfate infusion and the incidence of postoperative AKI until postoperative day (POD) 3 using a multivariable logistic regression analysis. We included 3,828 patients in this analysis; 357 patients (9.3%) received an intraoperative magnesium sulfate infusion and 186 patients (4.9%) developed postoperative AKI by POD 3. A multivariable logistic regression analysis showed that magnesium infusion was associated with a significant decrease (63%) in postoperative AKI (odds ratio, 0.37; 95% confidence interval, 0.14–0.94; P = 0.037). Our study suggested that intraoperative magnesium sulfate infusion is associated with a reduced risk of postoperative AKI until POD 3 for patients who underwent laparoscopic major abdominal surgery. Well-designed, prospective studies should be conducted to further substantiate these findings.

We examined the use of neostigmine for reversing shallow (defined as train-of-four ratio of 0.5), cisatracurium- and rocuronium-induced neuromuscular block in 112 patients, by use of 0 μg.kg(-1) , 10 μg.kg(-1) , 20 μg.kg(-1) or 40 μg.kg(-1) dose of neostigmine for reversal. The times from neostigmine administration to train-of-four ratios of 0.7, 0.9 and 1.0 were evaluated. Analysis of variance showed that the duration of action was significantly longer after cisatracurium compared with rocuronium. The time to reach a train-of-four ratio of 1.0 was significantly shorter with neostigmine 40 μg.kg(-1) compared with lower neostigmine doses, and at this dose the time did not differ between cisatracurium and rocuronium. The recovery time from a train-of-four ratio of 0.5-1.0 did not differ between cisatracurium and rocuronium, and was significantly shortened by the administration of neostigmine. We conclude that a neostigmine dose of 40 μg.kg(-1) was the most effective at reducing recovery time after neuromuscular blockade.

We assessed whether intraoperative nefopam would reduce opioid consumption and relieve postoperative pain in patients undergoing laparoscopic gastrectomy. The 60 enrolled patients were randomly assigned to the control (n = 32) or nefopam (n = 28) group. All patients were blinded to their group assignment. We administered 100 ml of normal saline only (control group) or 20 mg of nefopam mixed in 100 ml normal saline (nefopam group) after anesthesia induction and at the end of surgery. The cumulative amount of fentanyl via intravenous patient-controlled analgesia (PCA), incidence of rescue analgesic medication, and numerical rating scale (NRS) for postoperative pain were evaluated along with the total remifentanil consumption. The mean infusion rate of remifentanil was significantly lower in the nefopam group (0.08 ± 0.05 μg/kg/min) than in the control group (0.13 ± 0.06 μg/kg/min) (P

Background: Intraoperative neuromuscular blocker is widely used, but is known to be associated with postoperative residual paralysis, which is known to be associated with increased risk of pulmonary complications. Hence, its use should be individualized and restricted to procedures where it is mandatory. We examined whether not using a neuromuscular blocker affects the surgical conditions in children undergoing inguinal herniorrhaphy. Methods: Anesthesia was induced and maintained with sevoflurane in 60% nitrous oxide, and the airway was maintained using an I-gel. In total, 66 children aged 1 to 6 years were randomized to receive rocuronium (rocuronium group, n = 33) or saline (control group, n = 33); 61 children of them finished the study. A single surgeon who performed the operation rated the surgical condition of each patient on a 4-point scale (1 = poor, 2 = acceptable, 3 = good, and 4 = excellent). Intraoperative patient movement, recovery time, emergence agitation, and postoperative pain scores were evaluated. Results: One patient in control group and no patient in rocuronium group showed intraoperative movement. When noninferiority test was done for intraoperative patient movement, with the noninferiority margin of 20%, the difference of absolute risk was 3.3% (95% confidence interval −8.0% to 16.7%) and saline group was noninferior to rocuronium group. All of the patients showed good to excellent surgical conditions, and no difference was found between the 2 groups. The recovery time was shorter in the control group than in the rocuronium group (4.5 ± 1.8 vs 5.6 ± 2.2 minutes, respectively; P = .028). Conclusion: In children aged 1 to 6 years undergoing inguinal herniorhaphy under sevoflurane anesthesia using an I-gel, not using neuromuscular blocker showed similar intraoperative condition and shortened recovery time compared with using neuromouscular blocker.

Brønsted acid-catalyzed reactions of α-pinene have been studied because of their ability to produce various types of fragrance molecules. Beyond this application, dimeric hydrocarbon products produced from coupling reactions of α-pinene have been suggested as renewable high-density fuel molecules. In this context, this paper presents the application of a sulfated tin(IV) oxide catalyst for the partial coupling reaction of α-pinene from turpentine. Brønsted acid sites inherent in this solid superacid catalyst calcined at 550 °C successfully catalyzed the reaction, giving the largest yield of dimeric products (49.6%) at 120 °C over a reaction time of 4 h. Given that the low-temperature viscosity of the mentioned dimeric products is too high for their use as a fuel in transportation engines, lowering the viscosity is an important avenue of study. Therefore, our partial coupling reaction of α-pinene provides a possible solution as a considerable amount of the isomers of α-pinene still remained after the reaction, which reduces the low-temperature viscosity. On the basis of a comparison of the reaction products, a plausible mechanism for the reaction involving coinstantaneous isomerization and coupling reaction of α-pinene was elucidated.

This study investigated the effectiveness of mechanical refining to overcome the biomass recalcitrance barrier. Laboratory scale refining was conducted via PFI mill and valley beater refiners using green liquor and Kraft hardwood pulps. A strong positive correlation was determined between sugar recovery and water retention value. Refining produced significant improvements in enzymatic hydrolysis yield relative to unrefined substrates (e.g., sugar recovery increase from 67% to 90%, for 15% lignin Kraft pulp). A maximum absolute enzymatic hydrolysis improvement with refining was observed at enzymatic hydrolysis conditions that produced intermediate conversion levels. For a 91% target sugar conversion, PFI refining at 4000 revolutions allowed for a 32% reduction in enzyme charge for 15% lignin content hardwood Kraft pulp and 96 h hydrolysis time, compared to the unrefined material.

Sum frequency generation (SFG) vibration spectroscopy can selectively detect crystalline cellulose without spectral interference from cell wall matrix components. Here, we show that the cellulose SFG spectrum is sensitive to cellulose microfibril alignment and packing within the cell wall. SFG intensity at 2,944 cm−1 correlated well with crystalline cellulose contents of various regions of the Arabidopsis (Arabidopsis thaliana) inflorescence, while changes in the 3,320/2,944 cm−1 intensity ratio suggest subtle changes in cellulose ordering as tissues mature. SFG analysis of two cellulose synthase mutants (irx1/cesa8 and irx3/cesa7) indicates a reduction in cellulose content without evidence of altered cellulose structure. In primary cell walls of Arabidopsis, cellulose exhibited a characteristic SFG peak at 2,920 and 3,320 cm−1, whereas in secondary cell walls, it had peaks at 2,944 and 3,320 cm−1. Starch (amylose) gave an SFG peak at 2,904 cm−1 (CH methine) whose intensity increased with light exposure prior to harvest. Selective removal of matrix polysaccharides from primary cell walls by acid hydrolysis resulted in an SFG spectrum resembling that of secondary wall cellulose. Our results show that SFG spectroscopy is sensitive to the ordering of cellulose microfibrils in plant cell walls at the meso scale (nm to μm) that is important for cell wall architecture but cannot be probed by other spectroscopic or diffraction techniques.

Although organosolv pretreatment removed substantial amounts of lignin and xylan, the yield of glucan which is a major sugar source for fermentation to ethanol is more than 90% in most conditions of the organosolv pretreatment. Relative lignin contents of all pretreated biomass were more than 200 g kg−1, however enzymatic conversions were increased dramatically comparing to untreated biomass. Therefore the correlation between lignin and enzymatic hydrolysis could not be explained just by lignin content, and other changes resulting from lignin removal affected enzymatic hydrolysis. Results on enzymatic conversion and sugar recovery suggested that the critical temperature improving enzymatic hydrolysis significantly was between 120 °C and 130 °C. Microscopic analysis using Field emission scanning electron microscopy (FE-SEM) showed that structural lignin changes happened through organosolv pretreatment. Lignins were isolated from lignin carbohydrate complex (LCC) at the initial stage and then migrated to the surface of biomass. The isolated and migrated lignins were finally redistributed onto surface. These structural changes formed droplets on surface and increased pore volume in pretreated biomass. The increase in pore volume also increased available surface area and enzyme adsorption at initial stage, and thus enzymatic conversion increased significantly through organosolv pretreatment. It was verified that the droplets were mainly composed of lignin and the lignin droplets inhibited enzymatic hydrolysis through adsorption with cellulase.

An acid-free organosolv process was proposed to overcome the problems caused by acid catalyst in organosolv process, thereby producing ethanol from Liriodendron tulipifera effectively. Although relative lignin contents were above 20%, enzymatic conversion increased significantly to 65% at all conditions, and thus correlation between lignin and enzymatic conversion could not be explained using relative lignin content. Enzymatic conversion increased significantly above 65% regardless of temperature, which suggests the organosolv pretreatment with sodium hydroxide can be performed at lower temperature. FE-SEM showed that the process made the structure loose and broke down biomass through lignin dissolution. Wrinkle formation by alkaline swelling was also observed and it might increase surface area. Although pore-volume increased slightly, it was not the sole key factor for the organosolv pretreatment with sodium hydroxide. Increase in surface area and enzyme adsorption enhanced the enzymatic hydrolysis. Ethanol of 96% could be produced theoretically and it suggested that the acid-free organosolv process was an effective pretreatment method for bioethanol production from L. tulipifera.

In this study, dilute acid pretreatment of Liriodendron tulipifera was performed for enzymatic hydrolysis. As the pretreatment temperature was increased, enzymatic hydrolysis and enzyme adsorption yield also increased. The highest enzymatic hydrolysis yield was 57% (gig) and enzyme adsorption was 44% (gig). Enzymatic hydrolysis yield was determined with weight loss of pretreated biomass by enzyme, and enzyme adsorption was a percentage of enzyme weight attaching on pretreated biomass compared with input enzyme weight. When L. tulipifera was pretreated with 1% sulfuric acid at 160℃ for 5 min., hemi-cellulose was significantly removed in pretreatment, but the lignin contents were constant. Other changes in surface morphology were detected on biomass pretreated at 160℃ by a field emission scanning electron microscope (FESEM). A large number of spherical shapes known as lignin droplets were observed over the entire biomass surface after pretreatment. Hemicellulose removal and morphological changes improved enzyme accessibility to cellulose by increasing cellulose exposure to enzyme. It is thus evidence that enzyme adsorption is a significant factor to understand pretreatment effectiveness.

Purpose Surgery is the primary curative treatment for colorectal cancer; however, it remains a frightening procedure that can cause stress and pain in affected patients. Therefore, patients typically experience significant anxiety during the preoperative period, which has been associated with poorer outcome after surgery. This study aimed to evaluate the effect of an Internet-based informational video on preoperative anxiety level in patients with colorectal cancer. Methods This prospective, single-arm, observational study included patients scheduled to undergo elective colorectal cancer surgery, who did not have a history of previous surgery or major cognitive impairment. The primary outcome measure was the change in Amsterdam Preoperative Anxiety and Information Scale - Anxiety (APAIS-A) before and after watching a 5-min informational video (https://youtu.be/VzhtOMPUe4Q) during the preoperative period. Secondary outcome measures were the change in Hospital Anxiety and Depression Scale (HADS), length of postoperative hospital day, and postoperative morbidity. Results Thirty-two patients were enrolled. Anxiety was significantly decreased after watching the video (APAIS-A score: from 10.8 ± 3.7 to 8.2 ± 3.2, P < 0.001, mean reduction: 22.2%). HADS score was also significantly decreased (from 5.8 ± 4.4 to 4.0 ± 3.3, P = 0.001, mean reduction: 26.5%). All preoperative anxiety level did not significantly differ between patients who developed postoperative complication and those who did not. Conclusion The informational video was an effective tool to reduce preoperative anxiety. Viewing this video may confer a higher level of confidence and realistic expectations, as well as reducing patients' preoperative anxiety.

Characterization of by-products generated during organosolv pretreatments of yellow poplar wood was performed in the presence of sulfuric acid and sodium hydroxide catalysts to elucidate the effects on further biological fermentation and provide the preliminary data for utilization of organosolv lignin. Monomeric sugars contents were 2.2–7.7% in organosoluble fraction with acid catalyst, while significantly lower amount of sugars (0.2–0.3%) were determined in that of with alkali catalyst. However, the concentrations of monomeric sugars were very low to ferment directly. Therefore, the oligomeric sugars in organosoluble fraction should be recovered to improve the economic feasibility of the organosolv pretreatment. Higher concentrations of inhibitory compounds such as acetic acid, 5-HMF and furfural were determined in the organosoluble fraction with acid catalyst. However, the concentrations were lower than the minimum inhibitory concentration to the microorganism for further biological process regardless of catalyst. Thus, the compounds could not inhibit the biological fermentation of organosoluble fraction. Precipitates, solid by-products, were also characterized by diverse analytical methods and the analysis results revealed that the precipitates were mostly composed of lignin polymers regardless of catalyst. However, the structures could be slightly modified during pretreatment and mixed with come carbohydrates by chemical bonds and/or physical association.

Organosolv pretreatments which utilized sulfuric acid, sodium hydroxide and ammonia as catalysts were conducted to screen the effective catalyst for organosolv pretreatment of Liriodendron tulipifera. The enzy-matic hydrolysis was achieved effectively with sulfuric acid (74.2%) and sodium hydroxide (63.7%). They were thus considered as effective catalysts for organosolv pretreatment of L. tulipifera. The organosolv pre-treatments with sulfuric acid and sodium hydroxide showed a different behavior on the reaction mechanism. The pretreatment with sulfuric acid increased the biomass roughness and pore numbers. On the other hand, the pretreatment with sodium hydroxide enhanced the surface area due to the size reduction and minor defiberization which were caused by hemicellulose degradation at an initial stage and more de-fiberization by lignin degradation at a later stage. The organosolv pretreatment with sodium hydroxide was performed at several different conditions to evaluate effectiveness of sodium hydroxide as a catalyst for organosolv pretreatment. According to the results of enzymatic digestibility, the changes of chemical com-position and the morphological analysis of pretreated biomass, it was suggested that the pretreatment time impacted primarily on enzymatic hydrolysis. Increase in surface area during the pretreatment was a major cause for improvement in enzymatic digestibility when sodium hydroxide was used as a catalyst. Keywords : Liriodendron tulipifera, organosolv pretreatment, sulfuric acid catalyst, sodium hydroxide cat-alyst, enzymatic hydrolysis

An enormous amount of multimedia data will be trans-mitted by various devices connected to the wireless personal area network, and this network environment will require very high transmission capacity. In this letter, we apply multiple antennas to the MB-OFDM UWB system for high performance. With an emphasis on a preamble design for multi-channel separation, we address the channel estimation in the MB-OFDM system with multiple antennas. By properly designing each preamble so that the multiple antennas remain orthogonal in the time domain, the channel estimation can be applied to the MB-OFDM specification in the case of more than 2 transmit antennas. By using the multiple-antenna scheme and proposed channel estimation technique, the reliability and performance of the MB-OFDM system can be improved.

In order to investigate the possibility of using waste mushroom logs as a biomass resource for alternative energy production, the chemical and physical characteristics of normal wood and waste mushroom logs were examined. Size reduction of normal wood (145 kW h/tone) required significantly higher energy consumption than waste mushroom logs (70 kW h/tone). The crystallinity value of waste mushroom logs was dramatically lower (33%) than normal wood (49%) after cultivation by Lentinus edodes as spawn. Lignin, an enzymatic hydrolysis inhibitor in sugar production, decreased from 21.07% to 18.78% after inoculation of L. edodes. Total sugar yields obtained by enzyme and acid hydrolysis were higher in waste mushroom logs than in normal wood. After 24 h fermentation, 12 g/L ethanol was produced on waste mushroom logs, while normal wood produced 8 g/L ethanol. These results indicate that waste mushroom logs are economically suitable lignocellulosic material for the production of fermentable sugars related to bioethanol production.

In this paper, the channel estimation in multi-band OFDM (MB-OFDM) ultra-wideband (UWB) based multipleantenna transmission systems is studied. For multiple antennas, each preamble designed by the Zadoff-Chu sequence satisfies the orthogonal property in the time domain. Therefore, the proposed preambles can improve the system performance and be applied to MB-OFDM specification in the case of more than two transmit antennas.

Mechanical refining is widely used in the pulp and paper industry to enhance the end-use properties of products by creating external fibrillation and internal delamination. This technology can be directly applied to biochemical conversion processes. By implementing mechanical refining technology, biomass recalcitrance to enzyme hydrolysis can be overcome and carbohydrate conversion can be enhanced with commercially attractive levels of enzymes. In addition, chemical and thermal pretreatment severity can be reduced to achieve the same level of carbohydrate conversion, which reduces pretreatment cost and results in lower concentrations of inhibitors. Refining is versatile and a commercially proven technology that can be operated at process flows of ∼ 1500 dry tons per day of biomass. This paper reviews the utilization of mechanical refining in the pulp and paper industry and summarizes the recent development in applications for biochemical conversion, which potentially make an overall biorefinery process more economically viable.

The rapid dissemination of digital consumer electronics devices within home and personal area causes increments of multimedia communication and of home networking. In order to meet the demand for low cost, high performance wireless entertainment network, multiple transmitting and receiving antennas can be used in MB-OFDM system to attain high-rate transmission and to offer better quality of service. The MB-OFDM system with multiple antennas increases the transmission rate efficiently with low multiplication operations. With an emphasis on a preamble design for multi-channel separation, we address a channel estimation in MB-OFDM with MIMO antenna system. By properly designing each preamble for multiple antennas to be orthogonal in time domain, the channel estimation can be applied to the MB-OFDM proposal for IEEE 802.15.3a standard in the case of more than two transmitting antennas

The biodegradation and estrogenic activity of dibutylphthalate (DBP) were characterized in the white rot fungi, Phanerochaete chrysosporium, Trametes versicolor and Daldinia concentrica. The DBP resistance of these fungi was determined in a 2% malt extract agar medium. The biodegradation efficiency was tested in the concentration of 100 μM DBP, its degraded products were analyzed by HPLC and GC/MS, and the induction effect by DBP was measured by laccase and manganese peroxidase. The reduction of estrogenic effect was assayed by MCF-7 cell proliferation test and measurement of pS2 mRNA expression. Although the mycelium growth rate of D. concentrica was slow in the media containing DBP, its resistance to DBP was at the high concentration of 500 ppm. However, at the low concentration less than 100 ppm of DBP, the mycelium growth rates of P. chrysosporium and T. versicolor were superior to D. concentrica. The induction of laccase was effective in T. versicolor, but not in D. concentrica and P. chyrysosporium. The degradation efficiency was 94% in D. concentrica, 83% in T. versicolor after first day of incubation, and completely degraded after 6 days of incubation. However, proliferation of the cell lines was significantly blocked when the cells were incubated in the DBP culture medium of D. concentrica after 6 days of incubation. The levels of pS2 mRNA expression were decreased in supernatant from DBP treated with D. concentrica compared with DBP only treatment after one day of incubation.

Cryptographic applications, such as data confidentiality and authentication, must be used for secure data communications. PRNG(Pseudo-Random Number Generator) is a basic cryptographic component which is supposed to be satisfied by criteria that we provable security and randomness properties. PRNG it used for generating an initial value or key value of cipher and security of whole cryptographic module depends on the security of PRNG. In this paper, we introduce an PRNG based on a block cipher and prove their security.

Desflurane is the most pungent of the currently used volatile anesthetics. We assessed whether the incidence of perioperative upper respiratory events in children undergoing general anesthesia via a supraglottic airway is higher with desflurane than with sevoflurane as maintenance anesthetic.We retrospectively reviewed and analyzed the electronic medical records of consecutive children 1 to 15 years of age who underwent general anesthesia via a supraglottic airway at Seoul National University Bundang Hospital between June 2013 and June 2015. The patients were assigned to the sevoflurane or desflurane group according to the anesthetic used. The characteristics of the patients were compared. The primary outcome variable was the incidence of upper respiratory events.The incidence of upper respiratory events in the 3439 evaluated patients was 0.43% (12/2777) in the sevoflurane group and 0.30% (2/662) in the desflurane group (P = 0.75; odds ratio = 0.69 [95% confidence interval = 0.16-3.13]). The difference between the 2 groups was not significant.Compared with sevoflurane, desflurane does not increase the risk of perioperative upper respiratory events in children receiving general anesthesia via a supraglottic airway.

Breast cancer surgery is known to cause severe acute postoperative pain, which can persist for a long time. We administered nefopam preventively to patients undergoing lumpectomy with axillary lymph node dissection or sentinel lymph node biopsy, and evaluated its efficacy on acute and chronic postoperative pain. Enrolled patients were assigned to the nefopam (n = 41) or the control (n = 42) group. Before initiating the operation, 20 mg of nefopam was given to the patients of the nefopam group, and normal saline was used in the control group. Ketorolac was given at the end of surgery, and meloxicam was prescribed in the postoperative period to all patients in both groups. Pain was assessed using a numerical rating scale (NRS), and the rescue analgesic drug was given when the NRS was >5. Implementation of postoperative chemotherapy, radiotherapy (RT), or hormone therapy was evaluated. The NRS of postoperative pain was significantly lower in the nefopam than in the control group in the postanesthetic care unit (4.5 ± 2.2 vs 5.7 ± 1.5, respectively; P = 0.01), at postoperative 6 h (3.0 ± 1.6 vs 4.5 ± 1.3, respectively; P